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Most Tel Aviv parents who refuse to vaccinate their children for ideological reasons belong to the middle and upper classes, a new study by the city's public health department found.

The study, which was presented yesterday at an annual nurses' convention in Tel Aviv, also found that of the approximately 6,000 Tel Aviv children due to receive a vaccination in 2004, some 400 failed to do so.

Vaccinating children against severe or infectious diseases is a mainstay of any public health system, and it is one of the factors that determine international rankings of how advanced a country's health system is. However, senior doctors say a growing number of Israeli parents refuse to vaccinate their children because they are ideologically opposed to immunization - a development that could eventually spawn new local outbreaks of the diseases in question. The study was conducted in order to gain an understanding of this development.

The study examined 685 files of children who were slated for a routine vaccination in 2004, but failed to complete the process. Since some children had multiple vaccination files open, 685 files translates into fewer than 685 children, the researchers noted. The files cover vaccinations for all the standard diseases for which the Health Ministry recommends immunization, including polio, tetanus, hepatitis, whooping cough, rubella and measles.

According to Anat Amit Aharon, the head nurse of Tel Aviv's public health department and the person who presented the findings to the convention, the study found that 503 of these files - 73 percent of the total - belonged to children of middle-class or wealthy parents.

Ideological reasons

Moreover, the study found, fully 70 percent of the middle-class or wealthy parents who refused to vaccinate their children did so for ideological reasons. By contrast, only 19 percent of needy parents (including migrant laborers and asylum seekers) cited ideology as their reason for failing to vaccinate a child, while 78 percent cited technical or bureaucratic reasons.

The researchers did not interview any of the parents directly, however. Instead, they relied on the explanations written in the case files by nurses at the Tipat Halav well-baby clinics, where vaccinations are usually conducted.

"In recent years, we have witnessed a phenomenon of parents who refuse to vaccinate [their children] for ideological reasons, a lack of understanding on the parents' part of the importance of immunization, and sometimes even isolated cases [three in total] of neglect of the baby's care," the researchers concluded.

However, they added, because it is the parents who decide not to immunize a child, further research is needed to determine exactly what factors lead parents to refuse vaccination. After that, they said, a plan of action must be drawn up to address the problem - for instance, by giving parents more information about the importance of vaccination.